Physician Penalized With $4.2M In Claims Fraud Settlement

Physician Penalized With $4.2M In Claims Fraud Settlement

Introduction

A Connecticut-based physician and several of his companies have been forced to pay $4.2 million in damages for filing fraudulent claims for payment to Medicare and the state Medicaid programme for inappropriate billing and needless services.

The state and federal settlements centre on a pulmonologist and his DOCS-branded enterprises, including DOCS Medical Group, Lung DOCS of CT, Epic Family Physicians, and Continuum Medical Group.

The defendant and DOCS were forced to pay $4,267,950.21 in damages, and the pulmonologist was ordered to sign an Integrity Agreement that included compliance requirements and yearly claim reviews. The defendant owns approximately 20 locations that provide general care, urgent care, allergy testing and treatment, and COVID testing.

According to investigators, between 2014 and 2019, filed claims showing services supplied by the defendant on days he was out of the country were instead conducted by lower-level providers, who typically receive a lesser payment rate from Medicare and Medicaid for those services.

There were also claims for medically unnecessary yearly allergy re-testing in patients, as well as claims for medically unnecessary immunotherapy services. When it came to delivering COVID tests, the government claimed DOCS, and the defendant invoiced Medicare and state Medicaid for them as assessment and management office visits.

The defendant and his extensive network of urgent care facilities were involved in a long-running plan to overbill the state and federal governments for medically inappropriate treatment as well as therapy that he and his crew never delivered. Aside from a $4.2 million fine, the defendant and his clinic's billing will be subject to continued inspection and examination to ensure that these inappropriate actions do not occur again.